腎病末期病人之安寧療護－最後一哩路的陪伴

Use Palliative Care with the End Stage Renal Disease Last Mile

10.6530/YYN.2012.6(2).03

楊婉伶(Wan-Ling Yang)；李存白(Chun-Pai Lee)；陳小妮(Hsiao-Ni Chen)

末期腎病 ； 透析 ； 安寧療護 ； 預立醫療照顧計畫 ； 善終 ； End stage renal disease ； Dialysis ； Palliative Care ； Advance care plan ； Good death

源遠護理

6卷2期（2012 / 11 / 01）

15 - 21

繁體中文

醫療技術日益進步，因透析延長壽命的病人愈來愈多，讓生命末期的議題逐漸受重視，“現代＂醫師應跳脫對無效醫療者搶救到底或延長生命的窠臼，接受實證醫療研究所指出的安寧緩和照護模式以提昇末期病人之生活品質。中央健保局自2009年9月1日起，新增八類非癌末期疾病包括腎臟衰竭，納入安寧療護給付範圍內，提供全方位（全人、全家、全程、全隊、全社區）的人性化照護，顯現對生命的尊重。本文擬由臨床經驗與實證文獻查證，剖析末期腎病病人對安寧療護之照護需求，內文包含介紹末期腎病病人、家屬與醫療團隊的身心靈困境，腎病末期症狀處理，釐清停止透析的時機，期能及早開啟醫療人員與透析病人和家屬有關病情、治療的對話，於溝通過程中尊重病人的自主性，建立良好信任的醫病關係，強化末期腎病病人預立醫療照顧計畫的動機，進而推廣器官捐贈的大愛。安寧療護經整體性評估，真誠與無條件的關懷，回顧有意義的人生和重要心願之完成，使其以正向態度面對生老病死的人生常態，把握機會向親人四道人生（道愛、道恩、道歉、道別），達到善終、善別、善生。

Based on clinical experience and literature review, this article discusses the needs of end-stage renal disease (ESRD) patients under hospice and palliative care, including ESRD disease process, family and medical team dilemma, and the decision point to discontinue dialysis. ESRD End-of-life issues drew attention as advanced medical technologies to prolong hemodialysis patients' live expectancy. Contemporary medicine challenges the traditional approach on treating patients for the sake of merely prolonging a patient's life. Evidence shows that during terminal stage, patients could benefit better quality of life from hospice and palliative care. On September 1, 2009, the Bureau of National Health Insurance added kidney failure to the hospice care that provides holistic support for both patient and family throughout the whole course with dedicated treatment team and community support. Early and open communication that respects a patient's autonomy will not only enhance a trusting relationship and a patient's motivation for advanced health care plan, but will also promote organ donation. Provision of comprehensive hospice care evaluation and sincere and unconditional care helps patients to reflect meaning in their life and complete their wishes. Guide patients to face the normalcy of life and death cycle, good living, good farewell and good death, and encourage patients to express their love, thanks, apology and goodbye to their family and friends.